When to use this diagnosis

• Clinical concern that alcohol is causing harm, but full diagnostic criteria for Alcohol Use Disorder, intoxication, withdrawal, or other specific alcohol‑related conditions are not met.
• Presentation is atypical, incomplete, or there is insufficient collateral information (e.g., emergency settings, medically unresponsive patients).
• Used temporarily as a working diagnosis pending further assessment, investigations or observation.

Common presentations

• Confusion, behavioural disturbance or mood symptoms after reported drinking but without clear intoxication or withdrawal signs.
• Self‑harm or risky behaviour where alcohol use is suspected but quantity/timing uncertain.
• Medical problems (falls, injuries) temporally linked to alcohol use but without documented dependence or withdrawal history.
• Patients with limited capacity or unreliable history where alcohol is a likely contributor.

Assessment approach

1. Obtain focused alcohol history: last drink, estimated quantity, pattern of use, prior withdrawal, and prior treatments (if available).
2. Use brief tools: AUDIT‑C or single‑item screening to gauge risk.
3. Perform medical and mental status examination: look for signs of intoxication (slurred speech, incoordination), withdrawal (tremor, autonomic arousal), and other medical causes.
4. Gather collateral information: family, EMS, pharmacy, or prior records where possible.
5. Order baseline investigations when indicated: blood glucose, electrolytes, LFTs, BAC (if available), ECG, and imaging if trauma suspected.
6. Assess safety: suicidal ideation, aggression, driving risk, and need for observation or admission.

Initial management

• Stabilise airway, breathing and circulation in acute presentations; manage agitation or severe behavioural disturbance per local protocols.
• If intoxicated: monitor until sober, provide supportive care, prevent aspiration, and ensure safe discharge planning.
• If withdrawal possible but uncertain: err on the side of safety — consider observation and CIWA‑Ar monitoring rather than immediate discharge.
• Address immediate medical needs (wounds, head injury) and provide thiamine if heavy drinking suspected.
• Provide brief advice on alcohol risks and document a plan for follow‑up and further assessment.

Follow‑up and further evaluation

• Arrange timely outpatient review (within days) for a full diagnostic assessment, including screening for Alcohol Use Disorder and comorbid mental health conditions.
• Consider referral to addiction services for those identified at risk or lacking support to reduce use.
• Use structured assessments and collateral to clarify diagnosis (e.g., timeline follow‑back, AUDIT, formal psychiatric assessment).
• Develop a safety and relapse‑prevention plan where necessary (contact numbers, brief psychosocial interventions, referral pathways).

When to treat or admit

• Signs of severe intoxication (loss of airway reflex, depressed consciousness) — emergency admission.
• Suspected alcohol withdrawal with autonomic instability or seizures — consider inpatient management and benzodiazepine protocol.
• Active suicidal ideation, severe psychosis, or inability to care for self — urgent psychiatric or medical admission.
• Significant medical comorbidity or high risk of complications (e.g., head injury, major trauma).